Iranian Journal Of Nursing and Midwifery Research
Volume:21 Issue: 1, Jan-Feb 2016

Human dignity, as a fundamental human right and a moral obligation, has been emphasized in different fields of nursing. The aim of the present integrative review was to explore the nature of nurses’ human dignity in educational and clinical settings.
A literature review was conducted on quantitative and qualitative research papers in English and Persian using the PubMed, ProQuest, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Google Scholar, SID, and Irandoc databases from the year 2000 to 2013. Keywords for the search included dignity, nursing, faculty, nurse clinicians, nursing student, and humanism. In total, 12 research papers met the inclusion criteria for the integrative review.
From this review, four key themes emerged. The themes consisted of concept of human dignity (it was as an expression of the professional value in nursing settings), factors affecting human dignity (including respect, communication, autonomy and power, competency and ability, structure of the workplace, and value‑based education), dimensions of human dignity (including intrinsic and professional domains), and consequences of human dignity [positive (individual and professional growth and caring professional behavior) and negative (loss of motivation, intention to leave the profession, and non‑professional image of nursing in the minds of people)].
The small number of studies found for the review indicates the need for further research in the field of nurses’ dignity. Recognizing nurses’ dignity can help to improve the nursing practice and provide them a dignified workplace.

Administration of quality care in the aged people requires having a positive attitude toward them. Numerous factors including nurses’ personality characteristics may play a role in their attitude toward the aged people. Therefore, the present study investigated the association between nurses’ personality characteristics and their attitude toward the aged people.
This is a cross‑sectional study conducted on 261 nurses selected through random stratified sampling. Kogan’s Attitudes toward Older People Scale (KAOPS) was adopted to measure nurses’ attitude toward the aged people, and five‑factor personality inventory was used to detect their personality dimensions. The data were analyzed by descriptive and inferential statistical tests (Pearson correlation coefficient and multiple linear regression). P Results showed that the predictive model of nurses’ attitude toward aged people based on their five‑factor personality dimensions was significant (P = 0.001). Overall, the variables, entered in the model, predicted 13% of variance of nurses’ attitude toward aged people. Among the predicting variables, two dimensions of personality, including agreeableness (P = 0.046) and neuroticism (P = 0.003), significantly predicted nurses’ attitude toward aged people.
The results showed that nurses with higher agreeableness and lower neuroticism can be an appropriate option in caring for the aged people. Therefore, nurse managers are suggested to take steps toward creating a more positive attitude toward the aged people among nurses, in addition to holding educational programs for them with the goal of agreeableness empowerment.

Improving the patients’ quality of life (QOL) after coronary artery bypass grafting (CABG) is one of the main concerns of the treatment team. Educational interventions may affect the aspects of QOL in various ways. The present study aimed to investigate the effect of education based on the main concepts of logotherapy approach on the CABG patients’ quality of life.
In this quasi‑experimental study, a convenient sample of 67 patients who had undergone CABG in Isfahan Chamran hospital were randomly allocated to two groups of experimental (n = 35) and control (n = 32). While the control group received routine care, the experiment group benefitted from logotherapy‑based education program (six 90‑min sessions, twice a week). SF‑36 questionnaire was completed by both two groups (before and 1 month after intervention). Descriptive and inferential statistical tests (consisting of independent t‑test) were employed to analyze data in SPSS version 13.
The pre‑test mean total score of SF‑36 questionnaire and also the mean scores of its eight dimensions were not significantly different between the two groups. The post‑test mean score change [Standard Error (SE)] in the intervention group was 24.95 (3) and in the control group was 9.27 (0.82). There were significant differences between the two groups (P Our findings indicated that the intervention has improved the patients’ QOL after CABG. Integration of such an intervention in these patients’ rehabilitation programs is recommended.

Attention to different aspects of self‑efficacy leads to actual evaluation of self‑efficacy about physical activity. This study was carried out in order to design and determine psychometric characteristics of a questionnaire for evaluation of self‑efficacy about leisure time physical activity (SELPA) among Iranian adolescent boys, with an emphasis on regulatory self‑efficacy.
This descriptive–analytic study was conducted in 734 male adolescents aged 15–19 years in Isfahan. After item generation and item selection based on review of literature and other questionnaires, content validity index (CVI) and content validity ratio (CVR) were determined and items were modified employing the opinions of expert panel (N = 10). Comprehensibility of the questionnaire was determined by members of target group (N = 35). Exploratory factors analysis (EFA) was operated on sample 1 (N1 = 325) and confirmatory factors analysis (CFA) on sample 2 (N2 = 347). Reliability of SELPA was estimated via internal consistency method.
According to EFA, barrier self‑efficacy and scheduling self‑efficacy are the two main aspects of SELPA with the total variance of 65%. The suggested model was confirmed by CFA and all fitness indices of the corrected model were good. Cronbach’s alpha was totally estimated as 0.89 and for barrier and scheduling self‑efficacy, it was 0.86 and 0.81, respectively.
The results provide some evidence for acceptable validity and reliability of SELPA in Iranian adolescent boys. However, further investigations, especially for evaluation of predictive power of the questionnaire, are necessary.

The introduction of antiretroviral therapy has caused a remarkable decrease in the occurrence of diseases and mortality among HIV‑positive patients, while this success has not been achieved among injection addicts due to a low adherence to antiretroviral medicine. This study aims at clarifying the important factors affecting adherence to treatment in addicts suffering from HIV.
In this qualitative research, data were gathered through in‑depth interviews and field notes, and were interpreted through content analysis in the form of constant comparison. The participants were 16 drug addicts living with HIV/AIDS. Most of them had records of imprisonment and were receiving Highly Active Antiretroviral Therapy (HAART) drug treatments in the AIDS center of Imam Khomeini Hospital complex, affiliated to Tehran University of Medical Sciences. Sampling was started in a purposive method and was continued until data were saturated.
Four main categories including psychological reactions, contradictory beliefs, perceived support, and individual and environmental barriers were extracted from the data, each having some sub‑categories.
The obtained results indicated that adherence to the treatment of HIV is not constant and mono‑dimensional, but is a function of different factors. Hence, an individual having feeble adherence in a specific time and under specific circumstances may show desirable adherence under a different circumstance. Thus, treatment of addicts living with HIV/AIDS requires physical, psychological, and social attention along with drug treatments.

The use of coping strategies in reducing the adverse effects of stress can be helpful. Nero‑linguistic programming (NLP) is one of the modern methods of psychotherapy. This study aimed to determine the effect of NLP on occupational stress in nurses working in critical care units of Urmia.
This study was carried out quasi‑experimentally (before–after) with control and experimental groups. Of all the nurses working in the critical care units of Urmia Imam Khomeini and Motahari educational/therapeutic centers, 60 people participated in this survey. Eighteen sessions of intervention were done, each for 180 min. The experimental group received NLP program (such as goal setting, time management, assertiveness skills, representational system, and neurological levels, as well as some practical and useful NLP techniques). Expanding Nursing Stress Scale (ENSS) was used as the data gathering tool. Data were analyzed using SPSS version 16. Descriptive statistics and Chi‑square test, Mann–Whitney test, and independent t‑test were used to analyze the data.
The baseline score average of job stress was 120.88 and 121.36 for the intervention and control groups, respectively (P = 0.65). After intervention, the score average of job stress decreased to 64.53 in the experimental group while that of control group remained relatively unchanged (120.96). Mann–Whitney test results showed that stress scores between the two groups was statistically significant (P = 0.0001).
The results showed that the use of NLP can increase coping with stressful situations, and it can reduce the adverse effects of occupational stress.

To respond efficiently to the increasing and new needs of people in health issues, it is necessary for nurses to develop their knowledge from hospital to society and to be equipped to play entrepreneur role in different levels of care. The present study was conducted to describe Iranian entrepreneur nurses’ perceived barriers to entrepreneurship, in order to identify the existing barriers.
This is a qualitative study in which Graneheim and Lundman’s content analysis method was employed. Thirteen entrepreneur nurses were chosen purposively, and data were gathered by unstructured interviews.
As a result of the data analysis, five major themes were extracted: Traditional nursing structure, legal limitations, traditional attitudes of governmental managers, unprofessional behaviors of colleagues, and immoral business.
The findings of the present study show that Iranian nurses are confronted with various problems and barriers to enter entrepreneur nursing and keep going in this area. By focusing on such barriers and applying appropriate changes, policymakers and planners in health can facilitate nurses entering into this activity.

Epilepsy exposes patients to many physical, social, and emotional challenges. Thus, it seems to portray a complex picture and needs holistic care. Medical treatment and psychosocial part of epilepsy remain central to managing and improving the patient’s qualify of life through team efforts. Some studies have shown the dimensions of self‑management, but its management process of epilepsy patients, especially in Iran, is not clear. This study aimed to determine the disease management process in patients with epilepsy in Iran.
This qualitative approach and grounded theory study was conducted from January 2009 to February 2012 in Isfahan city (Iran). Thirty‑two participants were recruited by the goal‑oriented, and snowball sample selection and theoretical sampling methods. After conducting a total of 43 in‑depth interviews with the participants, the researchers reached data saturation. Data were analyzed using Strauss and Corbin method.
With a focus on disease management process, researchers found three main themes and seven sub‑themes as a psychosocial process (PSP). The main themes were: perception of threat to self‑identity, effort to preserve self‑identity, and burn out. The psychosocial aspect of the disease generated one main variable “the perception of identity loss” and one central variable “searching for self‑identity.”
Participants attributed threat to self‑identity and burn out to the way their disease was managed requiring efforts to preserve their identity. Recommendations consist of support programs and strategies to improve the public perception of epilepsy in Iran, help patients accept their condition and preserve self‑identity, and most importantly, enhance medical management of epilepsy.

Supervisors should have certain characteristics and adequate preparation for their roles. Yet, there are no well‑educated experts knowing about the supervisor’s role and responsibilities and how to train them. So, this research was conducted with the purpose of finding the factors affecting nursing supervisor training.
This research is an inductive content analysis. Participants were 25 in number, consisting of nurses and supervisors in Shahid Sadoughi University hospitals. The participants were chosen by a purposive sampling method. Data collection was done by semi‑structured interviews and reviewing documents. Data were analyzed using conventional content analysis.
Findings included two main themes: Firstly, establishment of a supervisory infrastructure that includes “making the appointments and retention of supervisors, clarifying the duties and authority of supervisor, developing supervisory culture, specializing supervision, and conducting practice‑based training” and secondly, comprehensive supervisory competencies that include “acquiring scientific, managing, communicative, professional, ethical, pedagogical, and supporting adequacy.”
Clinical supervisor has a major role in ensuring the quality of nursing care. This leads to improvements in patient care and nurses’ personal and professional development. So, it is necessary that for effective supervision in nursing, first an infrastructure is provided for supervision and then the comprehensive competency of a supervisor is enhanced to apply effective supervision.

Parent–infant attachment is an important factor in accepting parenting role, accelerating infant survival, and adjusting to the environment outside the uterus. Since family supportive interventions can strengthen the parent–infant caring relationship, this study sought to investigate the relationship between mother–infant attachment and satisfaction of the mothers with the supportive nursing care received in the neonatal intensive care unit (NICU).
In this descriptive–correlational study, 210 mothers with premature infants who were hospitalized in the NICUs affiliated to Isfahan Medical University hospitals took part. The data were collected via Maternal Postnatal Attachment Scale and researcher’s self‑tailored questionnaire based on Nurse Parent Support Tool. Pearson correlation coefficient and multiple linear regressions were used to analyze the collected data.
The results showed that the overall score of mother–infant attachment and the overall score of maternal satisfaction correlated with a correlation coefficient of r = 0.195. Also, the overall score of mother–infant attachment and mothers’ satisfaction scores in the emotional, communicative‑informative, and self‑confidence domains correlated with correlation coefficients of r = 0.182, r = 0.0.189, and r = 0.0.304, respectively. The results of multiple regression analysis revealed that about 15% of changes in the dependent variable (mother–infant attachment) could be explained by different dimensions of mothers’ satisfaction.
The results of the study showed that mother–infant attachment improved by increasing mothers’ satisfaction of supportive nursing care. Therefore, it seems necessary to increase maternal satisfaction through given nursing care support, in order to promote mother–infant attachment.

Heart failure is one of the most important and prevalent diseases that may have negative effects on the quality of life (QOL). Today, the promotion of QOL in patients with heart failure is important in nursing care programs. This research aimed to determine the efficacy of hope‑promoting interventions based on religious beliefs on the QOL of patients with congestive heart failure (CHF).
In this randomized clinical trial (IRCT2014100619413N1) conducted in Isfahan, Iran, 46 adult patients with CHF were selected and randomly assigned to study and control groups. Ferrans and Powers Quality of Life Index (QLI) was completed by both groups before, immediately after, and 1 month after the intervention. For the study group participants and their families, 60‑min sessions of hope‑promoting interventions based on religious beliefs were held twice a week for 3 weeks. Independent t, repeated measures analysis of variance (ANOVA), Chi‑square, Mann–Whitney, and Fisher’s exact tests were adopted for data analysis.
The mean (standard deviation) overall QOL score in the area of satisfaction significantly increased in the study group, compared to the controls, immediately [70.7 (8.5) vs. 59.2 (12.5)] and 1 month after the intervention [75.2 (7.4) vs. 59.4 (12.9)] (P Hope‑promoting intervention based on religious beliefs is a useful method for improving QOL in patients with CHF.

Kangaroo mother care (KMC) is the most implementation intervention in caring of the infants, as in this method, both the mothers and infants are cared. The World Health Organization recommends implementation of KMC for all infants. However, there are some barriers in the way of its application. The purpose of this study was evaluation of the practical application of KMC and nurses’ perspective about its implantation barriers in the neonatal intensive care units (NICUs) in Iran.
The descriptive study was conducted on 96 infants and 80 nurses working in the NICUs of two university hospitals in Isfahan, Iran. Data were collected by a two-section questionnaire and analyzed by t-test through SPSS 14.
Study findings indicated that mean weight and age of the infants with KMC were 1510 g and 32 weeks, respectively. KMC was implantation for 32 min in a day. From nurses’ perspective, mother-related barriers were the main barriers in the implantation of KMC as mothers were not present by their infants. Another barrier was the mothers’ fear of touching their infants. In the domain of organizational barriers, physician’s order was found to be the most important barrier in application of KMC.
Identifying barriers in implantation of KMC is essential to support the mothers. Regarding mother-related barriers, organizational barriers, and the need for a physician’s order for implementation of KMC, policy makers must provide facilities and equipment for applying KMC practice for mothers and improve the protocol of KMC in the NICU.

After coronary artery bypass surgery, pulmonary complications and oxygenation disorders are common, which have an important role in mortality and morbidity. Different methods are used for the improvement of pulmonary function and oxygenation, of which incentive spirometry (IS) has been investigated here. The aim of this study is to evaluate the effects of IS on arterial blood gases after coronary artery bypass graft (CABG).
This was a clinical trial. Fifty patients who were candidates for CABG were chosen. The patients had been allocated to two random groups of intervention and control. The intervention was done through IS. These two groups were compared for the arterial blood gases’ preoperative level, and the levels on first (after extubation), second, and third postoperative days.
The study findings showed that on the third postoperative day, there was a significant difference between the intervention and control groups in the mean amount of arterial blood oxygen (82.3 ± 4.7 vs. 72.7 ± 7.1, respectively, P = 0.02), arterial blood carbon dioxide (36.8 ± 2 vs. 43.7 ± 3.2, respectively, P = 0.007), and oxygen saturation (96.8 ± 1.4 vs. 90.5 ± 1.4, respectively, P = 0.03).
This investigation shows that using IS is significantly effective in the improvement of blood arterial gas parameters.

Since suicide attempt among adolescents is a major challenge and the reasons why this age group attempt suicide are complex, the aim of this study was to investigate the risk factors that contribute to suicide attempt among adolescents.
In this qualitative content analysis, 14 adolescents (12–19 years old) who were admitted in two hospitals in Shiraz, Iran, were interviewed. Participants who tried attempt suicide with medication were selected by purposive sampling and the data were gathered by semi‑structured interviews. Data analysis was guided by the conventional approach of qualitative content analysis.
Three major themes and 13 subthemes emerged from data analysis. The main themes were: (a) Individual factors and experiences (psycho‑emotional problems, puberty, religious beliefs, stress management strategies, marriage and love, field and level of education); (b) family factors (family structure, family relationship, family economic features, family health conditions); and (c) social factors (suicidal behavior in others, media influence, professional support).
This study identified three major themes related to suicide attempt among adolescents in the context. As a result, suicide prevention and care provision should formulate a comprehensive method, considering the interaction of medical besides individual, familiar, and social factors in their assessment and care provision.

Vitamin D supplementation has been shown to decrease insulin resistance through which it might cause fatty liver. Fatty liver increasingly results in type 2 diabetes mellitus (T2DM). Insulin resistance and fatty liver are particularly closely related. The aim of present study is to examine the effect of vitamin D supplementation on blood sugar and different indices of insulin resistance in patients with non‑alcoholic fatty liver disease (NAFLD).
This randomized placebo‑controlled clinical trial was conducted on 60 patients with NAFLD, who were divided equally into intervention and control groups. Patients in the intervention group received vitamin D3 (50,000 IU) and patients in the control group received placebo capsules every week for 10 weeks. Blood sugar, homeostatic model assessment‑insulin resistance (HOMA‑IR), and homeostatic model assessment‑beta cell (HOMA‑B) were checked at baseline and after 10 weeks of the intervention. Adjustment for variables was performed by analysis of covariance (ANCOVA).
Vitamin D supplementation resulted in increased serum 25‑hydroxy vitamin D [25(OH) D] concentration in the intervention group compared to the control group [ (12) vs. −1.9 (2.44); P = 0.001]. Intake of vitamin D supplements led to a marginally significant decrease in fasting blood glucose [FBS: −12 (4) in the intervention group compared to − 3 (2) in the control group; P = 0.055]. Also, HOMA‑IR decreased in the intervention group compared to the control group [−1.75 (0.23) vs. 0.12 (0.41); P = 0.066].
Vitamin D supplementation resulted in decreased HOMA‑IR and FBS concentration in patients with NAFLD; however, it did not affect the insulin level and HOMA‑B significantly.

Sir,
The 2014 outbreak of Ebola virus disease has beendeclared as an international public health emergencyand since inception, the disease has accounted for almost27,550 cases and 11,235 associated deaths till the endof June 2015 in the affected countries.[1] A wide rangeof factors like lack of preparedness,[2] weak public healthsystem,[3] ineffective diagnostic and case managementservices,[4] absence of an effective vaccine,[3] and minimalcommunity participation[4,5] have allowed the currentoutbreak to grow to epidemic proportions. In fact, theretrospective assessment of the outbreak indicated that thedisease could have been tackled much better, provided thepublic health authorities had not failed to build a level oftrust and involve the members of the community.[2]